Expanding the role of Australian pharmacists in community pharmacies in chronic pain management - a narrative review
Chronic pain is a condition where patients continuously experience pain symptoms for at least 3 to 6 months. It is one of the leading causes of disabilities across the globe. Failure to adequately manage chronic pain often results in additional health concerns that may directly contribute to the worsening symptoms of pain. Community pharmacists are an important healthcare resource that contributes to patient care, yet their roles in chronic pain management are often not fully utilised. This review aimed to investigate and explore pharmacist-driven chronic pain educational and medication management interventions in community pharmacies on an international level, and thereby identify if there are potential benefits in modelling and incorporating these interventions in the Australian community. We found a number of studies conducted in Europe and the United States investigated the benefits of pharmacist-driven educational and medication management interventions in the context of chronic pain management. Results demonstrated that there were improvements in the pain scores, depression/anxiety scales and physical functionality in patient groups receiving the pharmacist driven-interventions, thereby highlighting the clinical benefit of these interventions in chronic pain. In conclusion, pharmacists are trustworthy and responsible advocates for medication reviews and patient education. There are currently very limited formal nationally recognised pharmacist-driven intervention programs dedicated to chronic pain management in Australian community pharmacies. International studies have shown that pharmacist-driven chronic pain interventions undertaken in community pharmacies are of benefit with regards to alleviating pain symptoms and adverse events. Furthermore, it is also clear that research around the application of pharmacist-led chronic pain interventions in Australia is lacking. Modelling interventions that have been conducted overseas may be worth exploring in Australia. The implementation of similar intervention programs for Australian pharmacists in community pharmacies may provide enhanced clinical outcomes for patients suffering from chronic pain. The recently implemented Chronic Pain MedsCheck Trial may provide some answers.
Merskey H, Bogduk N. Classification of chronic pain : descriptions of chronic pain syndromes and definitions of pain terms. 2nd ed. In: Merskey H, Bogduk N, editors. International Association for the Study of Pain. Seattle: IASP Press; 1994.
Strong J, Melzack R, Van Griensven H, Strong J, Unruh AM. Pain : a textbook for health professionals. Second edition. Edinburgh, NY: Churchill Livingstone/Elsevier; 2014.
Blyth FM, March LM, Brnabic AJM, Jorm LR, Williamson M, Cousins MJ. Chronic pain in Australia: a prevalence study. Pain. 2001;89(2-3):127-134. https://dx.doi.org/10.1016/S0304-3959(00)00355-9
Bupa. Chronic pain. Sydney NSW: Bupa. Available from: http://www.bupa.com.au/health-and-wellness/health-information/az-health-information/chronic-pain-fact-sheet (acessed Mar 23, 2017).
Pergolizzi J, Ahlbeck K, Aldington D, Alon E, Coluzzi F, Dahan A, Huygen F, Kocot-Kępska M, Mangas AC, Mavrocordatos P, Morlion B, Müller-Schwefe G, Nicolaou A, Pérez Hernández C, Sichère P, Schäfer M, Varrassi G. The development of chronic pain: physiological CHANGE necessitates a multidisciplinary approach to treatment. Curr Med Res Opin. 2013 Sep;29(9):1127-35. https://dx.doi.org/10.1185/03007995.2013.810615
Rudy TE, Kerns RD, Turk DC. Chronic pain and depression: toward a cognitive-behavioral mediation model. Pain. 1988;35(2):129-140. https://dx.doi.org/10.1016/0304-3959(88)90220-5
McWilliams L, Cox BJ, Enns MW. Mood and anxiety disorders associated with chronic pain: An examination in a nationally representative sample. Pain. 2003;106(1-2):127-133. https://dx.doi.org/10.1016/S0304-3959(03)00301-4
Wilson KG, Eriksson MY, D'Eon JL, Mikail SF, Emery PC. Major Depression and Insomnia in Chronic Pain. Clin J Pain. 2002;18(2):77-83.
Smith BH, Elliott AM, Chambers WA, Smith WC, Hannaford PC, Penny K. The impact of chronic pain in the community. Fam Pract. 2001;18(3):292-299
Breivik H, Collett B, Ventafridda V, Cohen R, Gallacher D. Survey of chronic pain in Europe: Prevalence, impact on daily life, and treatment. Eur J Pain. 2006;10(4):287-333. https://dx.doi.org/10.1016/j.ejpain.2005.06.009
van Grootheest AC, de Jong-van den Berg LTW. The role of hospital and community pharmacists in pharmacovigilance. Res Social Adm Pharm. 2005;1(1):126-133. https://dx.doi.org/10.1016/j.sapharm.2004.12.009
Benrimoj SI, Frommer MS. Community pharmacy in Australia. Aust Health Rev. 2004;28(2):238-246. https://dx.doi.org/10.1071/AH040238
Roberts AS, Benrimoj SI, Chen TF, Williams KA, Hopp TR, Aslani P. Understanding practice change in community pharmacy: A qualitative study in Australia. Res Social Adm Pharm. 2005;1(4):546-564. https://dx.doi.org/10.1016/j.sapharm.2005.09.003
Chan V, Tran H. Purchasing Over-the-counter medicines from Australian pharmacy: What do the pharmacy customers value and expect? Pharm Pract (Granada). 2016;14(3):782. https://dx.doi.org/10.18549/PharmPract.2016.03.782
Rubio-Valera M, Chen TF, O’Reilly CL. New Roles for Pharmacists in Community Mental Health Care: A Narrative Review. Int J Environ Res Public Health. 2014;11(10):10967-90. https://dx.doi.org/10.3390/ijerph111010967
Ashburn MA, Staats PS. Management of chronic pain. Lancet. 1999;353(9167):1865-1869. https://dx.doi.org/10.1016/S0140-6736(99)04088-X
Ryan R, Santesso N, Lowe D, Hill S, Grimshaw J, Prictor M, Kaufman C, Cowie G, Taylor M. Interventions to improve safe and effective medicines use by consumers: an overview of systematic reviews. Cochrane Database Syst Rev. 2014;(4):CD007768. https://dx.doi.org/10.1002/14651858.CD007768.pub3
Morgan TK, Williamson M, Pirotta M, Stewart K, Myers SP, Barnes J. A national census of medicines use: a 24-hour snapshot of Australians aged 50 years and older. Med J Aust. 2012;196(1):50-53. https://dx.doi.org/10.5694/mja11.10698
George PP, Molina J, Cheah J, Chan SC, Lim BP. The evolving role of the community pharmacist in chronic disease management-a literature review. Ann Acad Med Singapore. 2010;39(11):861-867.
Giummarra MJ, Gibson SJ, Allen AR, Pichler AS, Arnold CA. Polypharmacy and chronic pain: harm exposure is not all about the opioids. Pain Med. 2015;16(3):472-479. https://dx.doi.org/10.1111/pme.12586
Hinnant D. Controlling pain. Avoiding polypharmacy in treating chronic pain. Nursing. 1995;25(9):78.
Omboni S, Caserini M. Effectiveness of pharmacist’s intervention in the management of cardiovascular diseases. Open Heart. 2018;5(1):e000687. https://dx.doi.org/10.1136/openhrt-2017-000687
Tsuyuki RT, Johnson JA, Teo KK, Simpson SH, Ackman ML, Biggs RS, et al. A Randomized Trial of the Effect of Community Pharmacist Intervention on Cholesterol Risk Management: The Study of Cardiovascular Risk Intervention by Pharmacists (SCRIP). Arch Intern Med. 2002;162(10):1149-1155. https://dx.doi.org/10.1001/archinte.162.10.1149
Weinrauch LA, Segal AR, D’elia JA. Cardiovascular Risk Reduction and the Community Pharmacist. J Am Coll Cardiol. 2016;67(24):2855-2857. https://dx.doi.org/10.1016/j.jacc.2016.04.018
Mehuys E, Van Bortel L, De Bolle L, Van Tongelen I, Annemans L, Remon JP, Giri M. Effectiveness of a community pharmacist intervention in diabetes care: a randomized controlled trial. J Clin Pharm Ther. 2011;36(5):602-613. https://dx.doi.org/10.1111/j.1365-2710.2010.01218.x
Evans CD, Watson E, Eurich DT, Taylor JG, Yakiwchuk EM, Shevchuk YM, Remillard A, Blackburn D. Diabetes and Cardiovascular Disease Interventions by Community Pharmacists: A Systematic Review. Ann Pharmacother. 2011;45(5):615-628. https://dx.doi.org/10.1345/aph.1P615
Basheti IA, Reddel HK, Armour CL, Bosnic-Anticevich SZ. Improved asthma outcomes with a simple inhaler technique intervention by community pharmacists. J Allergy Clin Immunol. 2007;119(6):1537-1538. https://dx.doi.org/10.1016/j.jaci.2007.02.037
García-Cárdenas V, Sabater-Hernández D, Kenny P, Martínez-Martínez F, Faus MJ, Benrimoj SI. Effect of a pharmacist intervention on asthma control. A cluster randomised trial. Respir Med. 2013;107(9):1346-1355. https://dx.doi.org/10.1016/j.rmed.2013.05.014
Kovačević M, Ćulafić M, Jovanović M, Vučićević K, Kovačević SV, Miljković B. Impact of community pharmacists' interventions on asthma self-management care. Res Social Adm Pharm. 2018;14(6):603-611. https://dx.doi.org/10.1016/j.sapharm.2017.07.007
Bennett MI, Bagnall AM, Raine G, Closs SJ, Blenkinsopp A, Dickman A, Ellershaw J. Educational interventions by pharmacists to patients with chronic pain: systematic review and meta-analysis. Clin J Pain. 2011;27(7):623-630. https://dx.doi.org/10.1097/AJP.0b013e31821b6be4
Petkova VB. Education for arthritis patients: a community pharmacy based pilot project. Pharm Pract (Granada). 2009;7(2):88-93. https://dx.doi.org/10.4321/s1886-36552009000200004
Powers D, Hamilton C, Roberts K. Pharmacist intervention in methadone administration to cancer patients with chronic pain. Am J Hosp Pharm. 1983;40(9):1520-1523.
Hay EM, Foster NE, Thomas E, Peat G, Phelan M, Yates HE, Blenkinsopp A, Sim J. Effectiveness of community physiotherapy and enhanced pharmacy review for knee pain in people aged over 55 presenting to primary care: Pragmatic randomized trial. BMJ. 2006;333(7576):995.
Hadi MA, Alldred D, Briggs M, Munyombwe T, Closs S. Effectiveness of pharmacist-led medication review in chronic pain management: systematic review and meta-analysis. Clin J Pain. 2014;30(11):1006-1014. https://dx.doi.org/10.1097/AJP.0000000000000063
Bruhn H, Bond CM, Elliott AM, Hannaford PC, Lee AJ, McNamee P, Smith BH, Watson MC, Holland R, Wright D. Pharmacist-led management of chronic pain in primary care: results from a randomised controlled exploratory trial. BMJ Open. 2013;3(4). pii: e002361. https://dx.doi.org/10.1136/bmjopen-2012-002361
Bruhn H, Blyth A, Elliott A, Hannaford P, Holland R, Lee A, MacNamee P, Smith B, Watson M, Wright D, Bond C. Pharmacist-led management of chronic pain in primary care: The PIPPC study. J Epidemiol Community Health. 2011;65(Suppl 2):A13-A14. https://dx.doi.org/10.1136/jech.2011.143586.30
Marra CA, Cibere J, Grubisic M, Grindrod KA, Gastonguay L, Thomas JM, Embley P, Colley L, Tsuyuki RT, Khan KM, Esdaile JM. Pharmacist-initiated intervention trial in osteoarthritis: A multidisciplinary intervention for knee osteoarthritis. Arthritis Care Res (Hoboken). 2012;64(12):1837-1845. https://dx.doi.org/10.1002/acr.21763
Gammaitoni AR, Gallagher RM, Welz M, Gracely EJ, Knowlton CH, Voltis‐Thomas O. Palliative pharmaceutical care: a randomized, prospective study of telephone‐based prescription and medication counseling services for treating chronic pain. Pain Med. 2000;1(4):317-331.
Hoffmann W, Herzog B, Mühlig S, Kayser H, Fabian R, Thomsen M, Cramer M, Fiss T, Gresselmeyer D, Janhsen K. Pharmaceutical care for migraine and headache patients: a community-based, randomized intervention. Ann Pharmacother. 2008;42(12):1804-1813. https://dx.doi.org/10.1345/aph.1K635
Neilson AR, Bruhn H, Bond CM, Elliott AM, Smith BH, Hannaford PC, Holland R, Lee AJ, Watson M, Wright D, McNamee P. Pharmacist led management of chronic pain in primary care: costs and benefits in a pilot randomised controlled trial. BMJ Open. 2015 Apr 1;5(4):e006874. https://dx.doi.org/10.1136/bmjopen-2014-006874
Ware JE, Kosinski M, Keller SD. A 12-Item Short-Form Health Survey: Construction of Scales and Preliminary Tests of Reliability and Validity. Med Care. 1996;34(3):220-233.
Ware JE, Sherbourne CD. The MOS 36-Item Short-Form Health Survey (SF-36): I. Conceptual Framework and Item Selection. Med Care. 1992;30(6):473-483.
Bellamy N. WOMAC Osteoarthritis Index: User Guide IX: Nicholas Bellamy; 2008.
eTG complete. Chronic pain: overview, available at: https://tgldcdp.tg.org.au/ (accessed Mar 23, 2018)
Hogg MN, Gibson S, Helou A, DeGabriele J, Farrell MJ. Waiting in pain: a systematic investigation into the provision of persistent pain services in Australia. Med J Aust. 2012;196(6):386-390. https://dx.doi.org/5694/mja12.10140
Cannings J, Francis C, Jessop R. Consumer needs executive summary - 5th community pharmacy agreement. Canberra: Australian Government Department of Health; 2015.
Brabers AE, Van Dijk L, Bouvy ML, De Jong JD. Where to buy OTC medications? A cross-sectional survey investigating consumers’ confidence in over-the-counter (OTC) skills and their attitudes towards the availability of OTC painkillers. BMJ Open. 2013;3(9):e003455. https://dx.doi.org/10.1136/bmjopen-2013-003455
Koslow S. The value of OTC medicines in Australia. Sydney: Macquarie University Centre for the Health Economy; 2014.
Mullan J, Weston KM, Bonney A, Burns P, Mullan J, Rudd R. Consumer knowledge about over‐the‐counter NSAIDs: they don't know what they don't know. Aust N Z J Public Health. 2017;41(2):210-214. https://dx.doi.org/10.1111/1753-6405.12589
6th Community Pharmacy Agreement. Chronic pain Medscheck Trial. Australian Government Department of Health. Available from: http://6cpa.com.au/pharmacy-trial-program/chronic-pain-medscheck-trial/ (accessed Nov 13, 2018).
The authors hereby transfer, assign, or otherwise convey to Pharmacy Practice: (1) the right to grant permission to republish or reprint the stated material, in whole or in part, without a fee; (2) the right to print pr epublish copies for free distribution or sale; and (3) the right to republish the stated material in any format (electronic or printed). In addition, the undersigned affirms that the article described above has not previously been published, in whole or part, is not subject to copyright or other rights except by the author(s), and has not been submitted for publication elsewhere, except as communicated in writing to Pharmacy Practice with this document.
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License (CC-BY-NC-ND) that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
Author Self-Archiving Policy
Pharmacy Practice permits and encourages authors to post and archive the final pdf of the articles submitted to the journal on personal websites or institutional repositories after publication, while providing bibliographic details that credit its publication in this journal.